Not properly trained for ER?????

cebe385RN · Sep 19, 2009

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sbyramRN · Sep 19, 2009

I started my first job as an ER nurse in a Level 1 Trauma pediatric hospital. I LOVE IT. I am obviously not able to triage or be a trauma nurse, but I am able to do everything else. It was scary and hard when I first started out, and there are still some days when I look on the board to see who is coming and in and think " please don't give me that patient ", but I think a lot has to do with the team you are working with. A good team makes everything better! I am SOOOOOO glad I did NOT start out in Med Surg. I don't see how Med Surg can prepare you for the ER. Not even close. I think starting out in the ER has made me a better nurse. I have seen EVERYTHING there.

cheerychick · Sep 19, 2009

Just being honest here. When I first got out of RN school, I went straight to ICU, and was able to function. But now, 7 yrs later, now working in ER, i realize that I didn't know half enough of what I needed to. If something had went wrong, all it takes is a split second and a wrong decision to kill someone. It's too late to take it back and say, "I thought I was ready". I know that working as an EMT has probably given you exposure, but let me tell you, wait until you have walked a mile in a nurse's shoes. If you are so confident that ER would be no problem for you, then a year on Med/Surg should be no problem for you.

medicrn16 · Sep 19, 2009

Hey there! You didn't mention if you were working still as an EMT? Did you think about applying as a tech in the ED during school? Our Level 1 usually hires new GNs if they have worked in the unit as a tech for at least 6 months. Personally, I think you have great insight into the world of emergency medicine being an EMT. I was (and still am) a medic for 5 years before nursing school and did the advanced track to graduate in a year. You are more qualified to work in the ED than a grad who has NO experience, but don't know if they will believe that is enough. BUT...if you really want to work in the ED then start thinking about getting a job there now to 'get known'.

marilynmom, LPN, NP · Sep 19, 2009

For those asking about why not a new grad in an ER/ICU and why? It's simple.....you don't know what you don't know. Really it comes down to that. You just simply don't even realize it. I sometimes scare myself looking back on my lack of experience when I first started out. My gosh....lol But I can say that I got goood pretty darn fast. Not a single one of my patients died....partly because I worked with such an awesome team of nurses that would come running when I had a question or needed help. Things go bad and they go back fast.

But having said that I started out as a new grad in a level one trauma center PICU.

Most of the RNs I worked with, who have now been there for years and are EXCELLENT nurses, started off as new grads in the ICU/ER. The nurses that I worked with who were truly the best were the paramedic to RNs. When the resident is standing there shaking in his/her boots (believe me this happens) that RN can run the code easily.

I have seen MANY new grads do well, and MANY who did not.

Definitely get a job there as a tech while your in school.

FlyingScot, RN · Sep 19, 2009

On our first day of class, we were told the ASN degree is mostly Med/Surg oriented & that as new grads we would not be ready for ICU or ER...Does everyone here agree with that for the ER?

A new grad is a new grad is a new grad. No program, be it diploma,ASN,ADN or even BSN, will prepare you for working in an ER directly out of school. I think it's pretty crummy that an instructor in your program would actually say this to her students. Your chosen route to become a nurse is just fine.

bassadict69 · Sep 19, 2009

Hey there! You didn't mention if you were working still as an EMT? Did you think about applying as a tech in the ED during school? Our Level 1 usually hires new GNs if they have worked in the unit as a tech for at least 6 months. Personally, I think you have great insight into the world of emergency medicine being an EMT. I was (and still am) a medic for 5 years before nursing school and did the advanced track to graduate in a year. You are more qualified to work in the ED than a grad who has NO experience, but don't know if they will believe that is enough. BUT...if you really want to work in the ED then start thinking about getting a job there now to 'get known'.

I do still work part time for our parish EMS service as a Basic & will usually work a handful of shifts a month. Most if not all our ED around here require either completion of 1st level clinicals or require being a paramedic before hiring as a tech.

I know what I have seen on the floors while family members are in the hospital & I do not think the slower pace would be for me. Sure they have quite a bit of time running around to get it all done, but I have seen them spending quite a bit of time sitting at the nurses station gossiping & carrying on for quite a bit of time...I just do not think I could handle that!

On the other hand, carrying patients into the ED & seeing the nurses & Dr.'s surround the pt doing their jobs is a rush to me...just like pulling up to a scene, quickly surveying the situation, & getting busy doing what needs to be done! The way all the training comes rushing back to you when it is needed the most, the not knowing what to expect from one pt to the next...it is all what keeps me loving the job!

The entire purpose of my post is to start early trying to determine what to do when graduated. Last thing I want is to start over my head & fail!

MissBrittanyRN · Sep 19, 2009

Hey Emergency dept. new grads,

I am not biased against new grads working in the ER, but I have a question about how you feel prepared. Of course an excellent orientation goes a long way, but there is soooo much to know. In a specialty, although you want to know how to treat the WHOLE PERSON, you still have a limited number of diagnosis to greatly familiarize yourself with. In the emergency department, you never know what you will get, so I would feel the need to familiarize myself with EVERYTHING about everything lol. Like someone above said, you don't know what you don't know...nothing personal, but how does a new grad know everything that I would think (as an outsider) would need in emergency nursing? So my question is just how do you feel prepared. Do you just remember everything from nursing school, or have you been through an amazing orientation? Kudos to all of you new grads who are getting through in the emergency dept. I would just like to know how you are doing, as I am somewhat considering an urgent care center (not quite, ED, but....) Thanks, I can't wait to hear from some of the ED grads!

Sharingan · Sep 19, 2009

Many graduated students from my school went right into ER. One is now a clinical instructor. I think it's doable. Of course, as a new grad, anything is going to be difficult no matter where you go. It's all about learning. If your heart is set on that, I'd say go for it. I had one professor say that new grads should do med/surg to get some experience (especially for taking care of multiple patients) before going into ER or ICU. The other one said that she believed you should go into ER or ICU right away if that's what you want to do. So, I think it really depends on the individuals. Do what makes you happy!!

FirefighterDoug · Sep 19, 2009

We have a limited number of ER internships for new grads but the competition is fierce and there are many more applicants than positions. I do think going the tech route is the natural progression into the ER RN position. I would recommend all students to try and get on as a tech especially if your looking to go ER. Its a great way to figure out if the ER is really your cup of tea and the pay is better than most EMT-B jobs plus most tech schedules are very student friendly. We have had a few techs hired as RN's right out of school and they are all doing very well. Its not a given that if you tech that you will be offered a job but it does give you a leg up. If you have built a solid reputation and have the trust and respect of the ER staffI think your a great candidate for a new grad position even in a level one setting.

As techs we really do have our hands full taking care of our nurses but we are also always learning by watching you, you may not realize how much you teach us and even when you make that rare mistake its a learning opportunity for us. I have always thought that being a tech in the ER compliments my field experience as a FF/EMT and if and when I go to nursing school the years of working with the best in the field will benefit me greatly.

Virgo_RN, BSN, RN · Sep 19, 2009

I think, as a general rule, that no, most new grads are not ready for a busy ER setting. There are exceptions, and some of those have been mentioned. I'd also like to mention that med/surg is no cakewalk, and while it may not be where you want to ultimately end up, don't discount the value of the experience just one year on the med/surg unit can provide.

SummerGarden, BSN, MSN, RN · Sep 20, 2009

op: as a rn-bsn student i can safely state that bsn students who have never ever worked as rns do not have more skills and abilities then adn new grads. all new grads are new grads! i do not care how much time they precept on a specialty floor, they were not the rn in charge. they were students. however, similar to techs, the more exposure you have to a particular floor (not necessarily a specialty) will help you with that department in that hospital when you graduate.

also, to answer your other question... my adn instructors said the same about adns vs. bsns. on the other hand, these same instructors had children who became nurses that were also adn prepared that did not start out in medical surgical nursing. in fact, most of my instructors (former adns) went straight into ob, icu, step-down, and the ed! why was medical surgical nursing not necessary for them too??? hmm..... :coollook: i found out, from working as a tech, that my adn program steered grads toward medical surgical nursing because the local hospital had trouble filling positions at the time. period! maybe it is the same for you too???

by the way, i am still a new grad and feel that most of the nurses on here were eloquent in expressing their belief that a new grad does not belong in a specialty setting. i cannot argue against their points based upon years of experience. however, i can share my experience with medical surgical nursing and why i disagree.

i started out training and working on several medical surgical floors with an ultimate goal to become a trauma nurse. along with the fact that most of the floors i worked were poorly managed (as is typical of med surg), my exposure to various trauma patients has been limited. therefore, i do not think two years of further work experience would have prepared me for the ed!

in fact, two years on one floor will make you a competent nurse in that focus. that is all! trauma nurses have to be competent in the emergency interventions regarding all forms of trauma not just one or two! thus, i left my facility (i was unable to transfer into their ed and i was tired of hearing excuses) and recently landed an ed job post 9 months medical surgical nursing experience.

am i prepared to be an er nurse..? nope, but i know that there is no true way to prepare for emergency nursing except to do the job while gaining additional training and education! in addition, as other new grads have pointed out, having a supportive team to back you up and save your you-know-what (an aspect that is necessary in all aspects of nursing, not just the ed) is helpful too!

-new er nurse